Compositions of an anticonvulsant and an antipsychotic drug and methods of using the same for affecting weight loss

ABSTRACT

Disclosed are compositions for affecting weight loss comprising a first compound and a second compound, where the first compound is a psychotherapeutic agent and the second compound is a anticonvulsant. Also disclosed are methods of affecting weight loss, increasing energy expenditure, increasing satiety in an individual, or suppressing the appetite of an individual, comprising identifying an individual in need thereof and treating that individual with a psychotherapeutic agent and an anticonvulsant.

RELATED APPLICATIONS

The present application is a continuation of, and claims priority to,U.S. patent application Ser. No. 11/034,316, filed on Jan. 11, 2005, nowU.S. Pat. No. 7,429,580, issued on Sep. 30, 2008, which applicationclaims priority to U.S. Provisional Patent Application Ser. No.60/616,393, filed Oct. 5, 2004 by Gadde et al., and entitled“COMPOSITIONS OF AN ANTICONVULSANT AND AN ANTIPSYCHOTIC DRUG AND METHODSOF USING THE SAME FOR AFFECTING WEIGHT LOSS,” U.S. Provisional PatentApplication Ser. No. 60/567,896, filed May 3, 2004 by Ranga Krishnan,and entitled “COMPOSITIONS FOR AFFECTING WEIGHT LOSS,” U.S. ProvisionalPatent Application Ser. No. 60/535,800, filed Jan. 13, 2004 by Gadde etal., and entitled “METHOD FOR REDUCING WEIGHT GAIN RISK ASSOCIATED WITHANTIDEPRESSANT THERAPY,” and U.S. Provisional Patent Application Ser.No. 60/535,799, filed Jan. 13, 2004 by Gadde et al., and entitled“METHOD FOR REDUCING WEIGHT GAIN RISK ASSOCIATED WITH ANTIDEPRESSANTTHERAPY,” all of which are incorporated herein by reference in theirentirety.

BACKGROUND OF THE INVENTION

1. Field of the Invention

The present invention is in the field of pharmaceutical compositions andmethods for the treatment of obesity and for affecting weight loss inindividuals.

2. Description of the Related Art

Obesity is a disorder characterized by the accumulation of excess fat inthe body. Obesity has been recognized as one of the leading causes ofdisease and is emerging as a global problem. Increased instances ofcomplications such as hypertension, non-insulin dependent diabetesmellitus, arteriosclerosis, dyslipidemia, certain forms of cancer, sleepapnea, and osteoarthritis have been related to increased instances ofobesity in the general population.

Obesity has been defined in terms of body mass index (BMI). BMI iscalculated as weight (kg)/[height (m)]². According to the guidelines ofthe U.S. Centers for Disease Control and Prevention (CDC), and the WorldHealth Organization (WHO) (World Health Organization. Physical status:The use and interpretation of anthropometry. Geneva, Switzerland: WorldHealth Organization 1995. WHO Technical Report Series), for adults over20 years old, BMI falls into one of these categories: below 18.5 isconsidered underweight, 18.5-24.9 is considered normal, 25.0-29.9 isconsidered overweight, and 30.0 and above is considered obese.

Prior to 1994, obesity was generally considered a psychological problem.The discovery of the adipostatic hormone leptin in 1994 (Zhang et al.,“Positional cloning of the mouse obese gene and its human homologue,”Nature 1994; 372:425-432) brought forth the realization that, in certaincases, obesity may have a biochemical basis. A corollary to thisrealization was the idea that the treatment of obesity may be achievedby chemical approaches. Since then, a number of such chemical treatmentshave entered the market. The most famous of these attempts was theintroduction of Fen-Phen, a combination of fenfluramine and phentermine.Unfortunately, it was discovered that fenfluramine caused heart-valvecomplications, which in some cases resulted in the death of the user.Fenfluramine has since been withdrawn from the market. There has beensome limited success with other combination therapy approaches,particularly in the field of psychological eating disorders. One suchexample is Devlin, et al., Int J. Eating Disord. 28:325-332, 2000, inwhich a combination of phentermine and fluoxetine showed some efficacyin the treatment of binge eating disorders. Of course, this disorder isan issue for only a small portion of the population.

In addition to those individuals who satisfy a strict definition ofmedical obesity, a significant portion of the adult population isoverweight. These overweight individuals would also benefit from theavailability of an effective weight-loss composition. Therefore, thereis an unmet need in the art to provide pharmaceutical compositions thatcan affect weight loss without having other adverse side effects.

SUMMARY OF THE INVENTION

Disclosed are compositions for affecting weight loss comprising a firstcompound and a second compound, where the first compound is apsychotherapeutic agent and the second compound is an anticonvulsant.

Disclosed are also methods of reducing the risk of weight gainassociated with the use of antidepressants or other antipsychotic drugs.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT

Newer generation antidepressants seem less likely to be associated withcardiovascular side effects and toxicity associated with oldergeneration antidepressants, such as tricyclic antidepressants ormonoamine oxidase inhibitors (MAOIs). Currently, newer generationantidepressants include selective serotonin reuptake inhibitors (e.g.,fluoxetine, fluvoxamine, sertraline, paroxetine, citalopram, andescitalopram), venlafaxine, duloxetine, nefazodone, mianserinsetiptiline, viqualine trazodone, cianopramine, and mirtazapine. Weightgain has been a major concern with certain of the newer antidepressants,particularly, with paroxetine (PAXIL® PAXIL CR®)) and mirtazapine (Fava,J. Clin. Psych. 61 (suppl. 11):37-41 (2000); Carpenter et al, J. Clin.Psych. 60:45-49 (1999); Aronne et al, J. Clin. Psych. 64 (suppl.8):22-29 (2003), both of which are incorporated by reference herein intheir entirety). A large proportion of patients treated with paroxetine,mirtazapine, and other antidepressants, such as venlafaxine (EFFEXOR®,EFFEXOR XR®), gain a significant amount of weight. Most of thesepatients find it difficult to lose the weight gained as a result oftreatment, even after discontinuing use of the particularantidepressant. Weight gain is unacceptable in patients and a majorreason for noncompliance with antidepressant therapy (Cash et al,Percep. Motor Skills 90:453-456 (2000); Deshmukh et al, Cleveland ClinicJ. Med. 70:614-618 (2003), both of which are incorporated by referenceherein in their entirety). Without being bound by any particular theory,it is believed that potential mechanisms for the observed weight gaininclude histamine H1 receptor antagonism for mirtazapine, andanticholinergic effects in the case of paroxetine.

Zonisamide is a marketed anticonvulsant indicated as adjunctive therapyfor adults with partial onset seizures. Without being bound by anyparticular theory, it is believed that the mechanism of antiepilepticactivity appears to be: 1) sodium-channel blocking; and, 2) reduction ofinward T-type calcium currents. In addition, zonisamide binds to theGABA/benzodiazepine receptor complex without producing change inchloride flux. Further, zonisamide facilitates serotonergic anddopaminergic neurotransmission and possesses a weak inhibitory effect oncarbonic anhydrase.

Zonisamide has been shown to cause significant weight loss (comparableto marketed weight loss medications) in patients presenting with primaryobesity (Gadde et al, JAMA 289:1820-1825 (2003), incorporated byreference herein in its entirety). It has been postulated that it is theeffect of zonisamide on the CNS concentration of serotonin, dopamine andcarbonic anhydrase that is responsible for this effect. There isevidence that zonisamide increases serotonin and dopamine synthesisrates (Hashiguti et al, J Neural Transm Gen Sect. 1993;93:213-223; Okadaet al, Epilepsy Res. 1992;13:113-119, both of which are incorporated byreference herein in their entirety). There is further evidencesuggesting that zonisamide stimulates dopamine D₂ receptors (Okada etal, Epilepsy Res. 1995;22:193-205, incorporated by reference herein inits entirety). Zonisamide was well tolerated, fatigue being the onlyside effect that occurred more frequently than with placebo treatment.

Thus, the present inventors have determined that the use ofanticonvulsants in general is effective in reducing or preventing theweight gain associated with the use of medications such asantidepressants, particularly newer generation of antidepressants,antihistamines, and serotonin receptor antagonists, such as 5HT_(2C)receptor antagonists.

Aspects of the present invention provide, at least in part, methods ofreducing the risk of weight gain associated with antidepressant therapy.These methods involve the use of weight-loss promoting anticonvulsants.The methods of the present invention are also effective againstindividuals who have gained weight irrespective of the use ofantidepressants.

Thus, in a first aspect, the present invention is directed to acomposition for the treatment of obesity or for affecting weight losscomprising a first compound and a second compound, where the firstcompound is a psychotherapeutic agent and the second compound is ananticonvulsant.

In certain embodiments, the anticonvulsant is effective in reducingconvulsions in a mammal. The mammal may be selected from the groupconsisting of mice, rats, rabbits, guinea pigs, dogs, cats, sheep,goats, cows, primates, such as monkeys, chimpanzees, and apes, andhumans.

In some embodiments the psychotherapeutic agent is an antidepressant, anantimigrane, an antibipolar, an antimania drug, a mood stabilizer, or anantiepileptic. Examples of antidepressants include paroxetine andmirtazapine. Examples of antimigrane drugs include sumatriptan,zolmitriptan, elatriptan and other triptans. Examples of antibipolardrugs include lithium, valproate, carbamezepine, oxycarbamezepine,lamotrogine, tiagabine, olanzapine, clozapine, risperidone, quetiapine,aripiprazole, ziprasidone, and benzodiazepines. In a some embodiments,the psychotherapeutic agent comprises a salt of lithium. In otherembodiments, the psychotherapeutic agent is valproate, which includesboth the salt of valproate and the free acid form of valproic acid. Alsoincluded are pharmaceutically acceptable salts or prodrugs of thesedrugs, extended release formulations of the above drugs, as well ascombinations of the above drugs. In some embodiments, the lithium saltmay be lithium carbonate or lithium citrate. In some embodiments, thelithium drug is in an extended release formulation.

In some embodiments, the present invention is directed to compositionscomprising zonisamide and a salt of lithium, as described herein and informulations described herein. In other embodiments, the presentinvention is directed to compositions comprising zonisamide and valproicacid, or a pharmaceutically acceptable salt, such as different salts ofvalproate, ester, amide, or prodrugs thereof.

In certain embodiments, the antidepressant is a compound of Formula I

where

W is nitrogen, CH, oxygen, or sulfur;

R₁ is selected from the group consisting of hydrogen, optionallysubstituted C₁₋₆ alkyl, optionally substituted C₃₋₈ cycloalkyl,optionally substituted C₂₋₆ alkenyl, optionally substituted C₂₋₆alkynyl, optionally substituted C₁₋₆ alkoxyalkyl, and optionallysubstituted aryl and arylalkyl;

R₂, R₃, R₄, and R₅, are each independently selected from the groupconsisting of hydrogen, halogen, optionally substituted C₁₋₆ alkyl,optionally substituted C₁₋₆ alkyloxy, optionally substituted C₂₋₆alkenyl, optionally substituted C₂₋₆ alkynyl, optionally substitutedC₁₋₆-alkoxyalkyl, optionally substituted C₁₋₆ alkylthio, perhaloalkyl,CN, COR₁₀, CONHR₁₀, heteroalkyl, and NO₂;

R₆, R₇, R₈, and R₉, are each independently selected from the groupconsisting of hydrogen, halogen, optionally substituted C₁₋₆ alkyl,optionally substituted C₁₋₆ alkyloxy, optionally substituted C₂₋₆alkenyl, optionally substituted C₂₋₆ alkynyl, optionally substitutedC₁₋₆-alkoxyalkyl, optionally substituted C₁₋₆ alkylthio, perhaloalkyl,CN, COR₁₀, CONHR₁₀, heteroalkyl, and NO₂.

The term “pharmaceutically acceptable salt” refers to a formulation of acompound that does not cause significant irritation to an organism towhich it is administered and does not abrogate the biological activityand properties of the compound. Pharmaceutical salts can be obtained byreacting a compound of the invention with inorganic acids such ashydrochloric acid, hydrobromic acid, sulfuric acid, nitric acid,phosphoric acid, methanesulfonic acid, ethanesulfonic acid,p-toluenesulfonic acid, salicylic acid and the like. Pharmaceuticalsalts can also be obtained by reacting a compound of the invention witha base to form a salt such as an ammonium salt, an alkali metal salt,such as a sodium or a potassium salt, an alkaline earth metal salt, suchas a calcium or a magnesium salt, a salt of organic bases such asdicyclohexylamine, N-methyl-D-glucamine, tris(hydroxymethyl)methylamine, and salts thereof with amino acids such as arginine,lysine, and the like.

A “prodrug” refers to an agent that is converted into the parent drug invivo. Prodrugs are often useful because, in some situations, they may beeasier to administer than the parent drug. They may, for instance, bebioavailable by oral administration whereas the parent is not. Theprodrug may also have improved solubility in pharmaceutical compositionsover the parent drug, or may demonstrate increased palatability or beeasier to formulate. An example, without limitation, of a prodrug wouldbe a compound of the present invention which is administered as an ester(the “prodrug”) to facilitate transmittal across a cell membrane wherewater solubility is detrimental to mobility but which then ismetabolically hydrolyzed to the carboxylic acid, the active entity, onceinside the cell where water-solubility is beneficial. A further exampleof a prodrug might be a short peptide (polyaminoacid) bonded to an acidgroup where the peptide is metabolized to provide the active moiety.

In another embodiment, the antidepressant is a tricyclicantidepressants. Examples of tricyclic antidepressants include, but arenot limited to, imipramine, desipramine, trimipramine, nortriptyline,clomipramine, doxepin, amitriptyline, maprotiline, protriptyline,dothiapen, setiptiline, cianopramine, and maprotiline. Maprotiline, avery effective antidepressant, is not used widely because it carriesrisk of seizures. The combination of maprotiline and zonisamide or otheranticonvulsants has the added benefit of reducing the risk of seizures,in addition to reducing the risk of weight gain due to the use of theantidepressant. The same is also true for combining zonisamide withclomipramine, another tricyclic associated with a relatively higher riskof seizures.

In further embodiments, the antidepressant is a monoamine oxidaseinhibitor (MAO inhibitor). Examples of MAO inhibitors include, but arenot limited to, phenelzine (Nardil®), tranylcypromine (Parnate®),isocarboxazid (Marplan®), moclobemide (Aurorix®), brofaromine ,cimoxatone, clorgyline, and lazabemide.

In certain embodiments, the antihistamine is one of setiptiline,teciptiline, ORG 8282 (Organon, Netherlands), or MO 8282 (Mochida,Japan).

In some embodiments, the 5HT_(2C) receptor antagonist is selected fromcolozapine, N-desmethylclozapine, and clozapine-N-oxide.

In some embodiments, the second compound is an anticonvulsant. Examplesof anticonvulsants include barbiturates, benzodiazepines, GABAanalogues, hydantoins, miscellaneous anticonvulsants, phenyltriazines,and succinimides. An example of a barbiturate includes pentobarbital.Examples of benzodiazepines include clonazepam, clorazepate,benzodiazepine, and diazepam. Examples of GABA analogues includetiagabine, pregabalin, and gabapentin. Examples of hydantoins includefosphenytoin, phenytoin, and 5,5-Diphenylhydantoin. Examples ofmiscellaneous anticonvulsants include carbarnazepine, valproate,valproic acid, divalproex, felbamate, levetiracetam, carbamazepine,topiramate, oxcarbazepine, and zonisamide. An example of aphenyltriazine is lamotrigine. Examples of succinimides includemethsuximide and ethosuximide. Also included are extended releaseformulations of the above drugs, pharmaceutically acceptable salts orprodrugs thereof, as well as combinations of the above drugs.

In one embodiment, the present invention is directed to a compositionfor the treatment of obesity or for affecting weight loss comprisingzonisamide and mirtazapine. In another embodiment, the present inventionis directed to a composition for the treatment of obesity or foraffecting weight loss comprising zonisarnide and paroxetine. In yetanother embodiment, the present invention is directed to a compositionfor the treatment of obesity or for affecting weight loss comprisingzonisarnide and venlafaxine.

In certain embodiments, the present invention is directed to aComposition for affecting weight loss or for preventing weight gaincomprising zonisamide and mirtazapine. In other embodiments, the presentinvention is directed to a composition for affecting weight loss or forpreventing weight gain comprising bupropion and mirtazapine. In furtherembodiments, the present invention is directed to a composition foraffecting weight loss or for preventing weight gain comprisingzonisamide and setiptiline. In other embodiments, the present inventionis directed to a composition for affecting weight loss or for preventingweight gain comprising bupropion and setiptiline. In additionalembodiments, the present invention is directed to a composition foraffecting weight loss or for preventing weight gain comprisingzonisamide, bupropion, and mirtazapine. In yet other embodiments, thepresent invention is directed to a composition for affecting weight lossor for preventing weight gain comprising zonisamide, bupropion, andsetiptiline.

Throughout the present disclosure, when a particular compound ismentioned by name, for example, zonisamide, bupropion, setiptiline,mirtazapine, or valproate, it is understood that the scope of thepresent disclosure encompasses pharmaceutically acceptable salts,esters, amides, or prodrugs of the named compound. Also, if the namedcompound comprises a chiral center, the scope of the present disclosurealso includes compositions comprising the racemic mixture of the twoenantiomers, as well as compositions comprising each enantiomerindividually substantially free of the other enantiomer. Thus, forexample, contemplated herein is a composition comprising the Senantiomer substantially free of the R enantiomer, or a compositioncomprising the R enantiomer substantially free of the S enantiomer. By“substantially free” it is meant that the composition comprises lessthan 10%, or less than 8%, or less than 5%, or less than 3%, or lessthan 1% of the minor enantiomer. If the named compound comprises morethan one chiral center, the scope of the present disclosure alsoincludes compositions comprising a mixture of the various diastereomers,as well as compositions comprising each diastereomer substantially freeof the other diastereomers. Thus, for example, commercially availablemirtazapine is a racemic mixture comprising two separate enantiomers.The recitation of “mirtazapine” throughout this disclosure includescompositions that comprise the racemic mixture of mirtazapine, thecompositions that comprise the (+) enantiomer substantially free of the(−) enantiomer, and the compositions that comprise the (−) enantiomersubstantially free of the (+) enantiomer.

In another aspect, the present invention relates to a method ofaffecting weight loss, comprising identifying an individual in needthereof and treating that individual with a psychotherapeutic agent andan anticonvulsant. The psychotherapeutic agent and the anticonvulsantare as described above.

In certain embodiments, the individual has a body mass index (BMI)greater than 25. In other embodiments, the individual has a BMI greaterthan 30 In still other embodiments, the individual has a BMI greaterthan 40. However, in some embodiments, the individual may have a BMIless than 25. In some of these embodiments, it may be beneficial forhealth or cosmetic purposes to affect weight loss, thereby reducing theBMI even farther. In some embodiments, the individual has reached theabove BMI as the result of antidepressant therapy. In other embodiments,the individual has reached the above BMI without the use ofantidepressants.

In some embodiments, the treating step of the above method comprisesadministering to the individual a first compound and a second compound,where the first compound is a psychotherapeutic agent and the secondcompound is a anticonvulsant.

In some embodiments the first compound and the second compound areadministered more or less simultaneously. In other embodiments the firstcompound is administered prior to the second compound. In yet otherembodiments, the first compound is administered subsequent to the secondcompound.

In certain embodiments, the first compound and the second compound areadministered individually. In other embodiments, the first compound andthe second compound are covalently linked to each other such that theyform a single chemical entity. The single chemical entity is thendigested and is metabolized into two separate physiologically activechemical entities; one of which is the first compound and the other oneis the second compound.

In certain embodiments, the first compound is zonisamide and the secondcompound is mirtazapine. In other embodiments, the first compound isbupropion and the second compound is mirtazapine. In furtherembodiments, the first compound is zonisamide and the second compound issetiptiline. In other embodiments, the first compound is bupropion andthe second compound is setiptiline. In additional embodiments, the firstcompound is a combination of zonisamide and bupropion and the secondcompound is mirtazapine. In yet other embodiments, the first compound isa combination of zonisamide and bupropion and the second compound issetiptiline.

In some embodiments, the first compound is zonisamide and the secondcompound is a salt of lithium, as described herein and in formulationsdescribed herein. In other embodiments, the first compound is zonisamideand the second compound is valproic acid, or a pharmaceuticallyacceptable salt, such as different salts of valproate, ester, amide, orpro drugs thereof.

In some embodiments, the first compound is topiramate and the secondcompound is a salt of lithium, as described herein and in formulationsdescribed herein. In other embodiments, the first compound is topiramateand the second compound is valproic acid, or a pharmaceuticallyacceptable salt, such as different salts of valproate, ester, amide, orprodrugs thereof.

In another aspect, the present invention relates to a method ofincreasing satiety in an individual comprising identifying an individualin need thereof and treating that individual with a first compound and asecond compound, where the first compound is a psychotherapeutic agentand the second compound is an anticonvulsant.

In some embodiments the first compound and the second compound areadministered nearly simultaneously. In other embodiments the firstcompound is administered prior to the second compound. In yet otherembodiments, the first compound is administered subsequent to the secondcompound.

In yet another aspect, the present invention relates to a method ofsuppressing the appetite of an individual comprising identifying anindividual in need thereof and treating that individual by administeringto the individual a first compound and a second compound, where thefirst compound is a psychotherapeutic agent and the second compound is aanticonvulsant.

In some embodiments the first compound and the second compound areadministered nearly simultaneously. In other embodiments the firstcompound is administered prior to the second compound. In yet otherembodiments, the first compound is administered subsequent to the secondcompound.

In certain embodiments, the first compound is zonisamide and the secondcompound is mirtazapine. In other embodiments, the first compound isbupropion and the second compound is mirtazapine. In furtherembodiments, the first compound is zonisamide and the second compound issetiptiline. In other embodiments, the first compound is bupropion andthe second compound is setiptiline. In additional embodiments, the firstcompound is a combination of zonisamide and bupropion and the secondcompound is mirtazapine. In yet other embodiments, the first compound isa combination of zonisamide and bupropion and the second compound issetiptiline.

In another aspect, the present invention relates to a method ofincreasing energy expenditure in an individual comprising identifying anindividual in need thereof and treating that individual by administeringto the individual a first compound and a second compound, where thefirst compound is a psychotherapeutic agent and the second compound is aanticonvulsant.

In some embodiments the first compound and the second compound areadministered nearly simultaneously. In other embodiments the firstcompound is administered prior to the second compound. In yet otherembodiments, the first compound is administered subsequent to the secondcompound.

In certain embodiments disclosed herein, an individual is given apharmaceutical composition comprising a combination of two or morecompounds to affect weight loss. In some of these embodiments, eachcompound is a separate chemical entity. However, in other embodiments,the two compounds are joined together by a chemical linkage, such as acovalent bond, so that the two different compounds form separate partsof the same molecule. The chemical linkage is selected such that afterentry into the body, the linkage is broken, such as by enzymatic action,acid hydrolysis, base hydrolysis, or the like, and the two separatecompounds are then formed.

Aspects of the present invention also relate to methods of reducing therisk of weight gain associated with the administration ofantidepressants, antihistamines, or serotonin receptor antagonists.Other aspects of the invention further relate to methods of minimizingmetabolic risk factors associated with weight gain, such ashypertension, diabetes and dyslipidaemia. In one embodiment, the methodscomprise administering to a mammal receiving an antidepressant an amountof zonisamide, or other weight-loss promoting anticonvulsant, sufficientto reduce the weight gain risk associated with the antidepressant. In analternative embodiment, the methods comprise administering to mammalreceiving an antidepressant a combination of zonisamide or topiramate,or other weight-loss promoting anticonvulsant (including agents thatblock kainate/AMPA (D,L-α-amino-3-hydroxy-5-methyl-isoxazole propionicacid) subtype glutamate receptors), and bupropion, or other compoundthat enhances the activity of norepinephrine and/or dopamine via uptakeinhibition or other mechanism, in an amount sufficient to reduce theweight gain risk associated with the antidepressant.

In certain embodiments, methods of the present invention are directed toreducing the risk of weight gain in an individual who already is onantidepressant therapy, or is about to begin antidepressant therapy. Inthese embodiments, in addition to the antidepressant, the individual isadministered a composition comprising an anticonvulsant and apsychotherapeutic drug, as described herein, where the psychotherapeuticdrug is not an antidepressant. Thus, in some embodiments, the individualwho is taking mirtazapine or setiptiline is administered a compositioncomprising zonisamide or a composition comprising zonisamide andbupropion. In other embodiments, the individual who is takingmirtazapine or setiptiline is administered a composition comprisingzonisamide or a composition comprising zonisamide and valproate. Infurther embodiments, the individual who is taking mirtazapine orsetiptiline is administered a composition comprising zonisamide or acomposition comprising zonisamide and venlafaxine.

In certain embodiments, the weight gain risk-reducing agents for use inthe methods of the present invention include zonisamide or topiramate(and pharmaceutically acceptable salts thereof). In other embodiments,other methane-sulfonamide derivatives, such as those described in U.S.Pat. No. 4,172,896, or other sulfamates (including sulfamate-substitutedmonosaccharides), such as those described in U.S. Pat. No. 4,513,006,incorporated by reference herein in its entirety, are used.

In further embodiments, the weight gain risk-reducing agent isbupropion; while in other embodiments, compounds disclosed in U.S. Pat.No. 3,819,706 and 3,885,046, both of which are incorporated by referenceherein in their entirety, are used. In additional embodiments, theweight gain risk-reducing agent is a compound that enhances the activityof norepinephrine and/or dopamine, such as by reuptake inhibition orother mechanism. All of the above-mentioned U.S. patents are.

Compounds that enhance the activity of norepinephrine and/or dopamineinclude norepinephrine agonists, such as phendimetrazine andbenzphetamine; norepinephrine reuptake inhibitors such as atomoxetine,bupropion, radafaxine, thionisoxetine, and reboxetine; dopamineagonists, such as cabergoline, amantadine, lisuride, pergolide,ropinirole, pranipexole, and bromocriptine; norepinephrine releasers,for example diethylpropion; a mixed dopamine/norepinephrine reuptakeinhibitor, for example, bupropion; a combination of a dopamine reuptakeinhibitor and a norepinephrine reuptake inhibitor, e.g. bupropion andmazindol; or a combination of a selective serotonin reuptake inhibitor(SSRI) and a norepinephrine reuptake inhibitor, such as sibutramine,venlafaxine, and duloxetine.

Mammals suitable for treatment in accordance with the instant inventioncan be receiving any antidepressant associated with weight gain.Typically, however, the antidepressant is a newer generationantidepressant (e.g., a selective serotonin uptake inhibitor (e.g.,fluoxetine, fluvoxamine, sertraline, paroxetine, citalopram, andescitalopram), venlafaxine, nefazodone, and mirtazapine)), particularly,paroxetine or mirtazapine.

The amount of weight gain risk-reducing agent(s) administered in thepharmaceutical compositions described herein can vary with the patient,the antidepressant that the patient is receiving, the route ofadministration and the result sought. Optimum dosing regimens forparticular patients can be readily determined by one skilled in the art.

In accordance with the invention, the combination of, for example,zonisamide or topiramate and bupropion (including sustained releasepreparations) provides an effective means of minimizing metabolic risksassociated with weight gain and/or antidepressant use (e.g., type IIdiabetes). The combination can be more effective than, for example,zonisamide or topiramate treatment alone and with fewer side effects.Neuropharmacologically, all three major nerve transmitters that regulateappetite and weight, i.e., serotonin, norepinephrine and dopamine, aretargeted with the combination of, for example, bupropion and zonisamideor topiramate. Side effects of, for example, zonisarnide or topiramate(such as somnolence, psychomotor slowing, cognitive impairment, fatigueand depression) can be offset by insomnia, activation, psychomotoragitation and antidepressant effects of, for example, bupropion. On theother hand, zonisamide or topiramate, for example, can reduce theseizure risk associated with, for example, bupropion. Lower doses ofboth types of medication can be used in the combination treatment,thereby further reducing the overall side effect burden.

With regard to the pharmacokinetics of zonisamide, its renal excretionand minimal potential for inhibition or induction of hepatic microsomalenzymes, are favorable qualities in the concept of combination use withantidepressants, particularly newer generation antidepressants.

In another aspect, the invention relates to a pharmaceutical compositioncomprising a combination of a psychotherapeutic agent and ananticonvulsant, as described above, or comprising a linked molecule, asdescribed herein, and a physiologically acceptable carrier, diluent, orexcipient, or a combination thereof.

Details of some embodiments of the appropriate routes of administrationand compositions suitable for same can be found in, for example, U.S.Pat. Nos. 6,110,973, 5,763,493, 5,731,000, 5,541,231, 5,427,798,5,358,970 and 4,172,896, as well as in patents cited therein, all ofwhich are incorporated by reference herein in their entirety, includingany drawings.

The term “pharmaceutical composition” refers to a mixture of a compoundof the invention with other chemical components, such as diluents orcarriers. The pharmaceutical composition facilitates administration ofthe compound to an organism. Multiple techniques of administering acompound exist in the art including, but not limited to, oral,injection, aerosol, parenteral, and topical administration.Pharmaceutical compositions can also be obtained by reacting compoundswith inorganic or organic acids such as hydrochloric acid, hydrobromicacid, sulfuric acid, nitric acid, phosphoric acid, methanesulfonic acid,ethanesulfonic acid, p-toluenesulfonic acid, salicylic acid and thelike.

The term “carrier” defines a chemical compound that facilitates theincorporation of a compound into cells or tissues. For example dimethylsulfoxide (DMSO) is a commonly utilized carrier as it facilitates theuptake of many organic compounds into the cells or tissues of anorganism.

The term “diluent” defines chemical compounds diluted in water that willdissolve the compound of interest as well as stabilize the biologicallyactive form of the compound. Salts dissolved in buffered solutions areutilized as diluents in the art. One commonly used buffered solution isphosphate buffered saline because it mimics the salt conditions of humanblood. Since buffer salts can control the pH of a solution at lowconcentrations, a buffered diluent rarely modifies the biologicalactivity of a compound.

The term “physiologically acceptable” defines a carrier or diluent thatdoes not abrogate the biological activity and properties of thecompound.

The pharmaceutical compositions described herein can be administered toa human patient per se, or in pharmaceutical compositions where they aremixed with other active ingredients, as in combination therapy, orsuitable carriers or excipient(s). Techniques for formulation andadministration of the compounds of the instant application may be foundin “Remington's Pharmaceutical Sciences,” Mack Publishing Co., Easton,Pa., 18th edition, 1990.

Suitable routes of administration may, for example, include oral,rectal, transmucosal, or intestinal administration; parenteral delivery,including intramuscular, subcutaneous, intravenous, intramedullaryinjections, as well as intrathecal, direct intraventricular,intraperitoneal, intranasal, or intraocular injections.

Alternately, one may administer the compound in a local rather thansystemic manner, for example, via injection of the compound directly inthe renal or cardiac area, often in a depot or sustained releaseformulation. Furthermore, one may administer the drug in a targeted drugdelivery system, for example, in a liposome coated with atissue-specific antibody. The liposomes will be targeted to and taken upselectively by the organ.

The pharmaceutical compositions of the present invention may bemanufactured in a manner that is itself known, e.g., by means ofconventional mixing, dissolving, granulating, dragee-making, levigating,emulsifying, encapsulating, entrapping or tabletting processes.

Pharmaceutical compositions for use in accordance with the presentinvention thus may be formulated in conventional manner using one ormore physiologically acceptable carriers comprising excipients andauxiliaries which facilitate processing of the active compounds intopreparations which can be used pharmaceutically. Proper formulation isdependent upon the route of administration chosen. Any of the well-knowntechniques, carriers, and excipients may be used as suitable and asunderstood in the art; e.g., in Remington's Pharmaceutical Sciences,above.

For injection, the agents of the invention may be formulated in aqueoussolutions, preferably in physiologically compatible buffers such asHanks's solution, Ringer's solution, or physiological saline buffer. Fortransmucosal administration, penetrants appropriate to the barrier to bepermeated are used in the formulation. Such penetrants are generallyknown in the art.

For oral administration, the compounds can be formulated readily bycombining the active compounds with pharmaceutically acceptable carrierswell known in the art. Such carriers enable the compounds of theinvention to be formulated as tablets, pills, dragees, capsules,liquids, gels, syrups, slurries, suspensions and the like, for oralingestion by a patient to be treated. Pharmaceutical preparations fororal use can be obtained by mixing one or more solid excipient withpharmaceutical combination of the invention, optionally grinding theresulting mixture, and processing the mixture of granules, after addingsuitable auxiliaries, if desired, to obtain tablets or dragee cores.Suitable excipients are, in particular, fillers such as sugars,including lactose, sucrose, mannitol, or sorbitol; cellulosepreparations such as, for example, maize starch, wheat starch, ricestarch, potato starch, gelatin, gum tragacanth, methyl cellulose,hydroxypropylmethyl-cellulose, sodium carboxymethylcellulose, and/orpolyvinylpyrrolidone (PVP). If desired, disintegrating agents may beadded, such as the cross-linked polyvinyl pyrrolidone, agar, or alginicacid or a salt thereof such as sodium alginate.

Dragee cores are provided with suitable coatings. For this purpose,concentrated sugar solutions may be used, which may optionally containgum arabic, talc, polyvinyl pyrrolidone, carbopol gel, polyethyleneglycol, and/or titanium dioxide, lacquer solutions, and suitable organicsolvents or solvent mixtures. Dyestuffs or pigments may be added to thetablets or dragee coatings for identification or to characterizedifferent combinations of active compound doses.

Pharmaceutical preparations which can be used orally, includingsublingually, which include include push-fit capsules made of gelatin,as well as soft, sealed capsules made of gelatin and a plasticizer, suchas glycerol or sorbitol, The push-fit capsules can contain the activeingredients in admixture with filler such as lactose, binders such asstarches, and/or lubricants such as talc or magnesium stearate and,optionally, stabilizers. In soft capsules, the active compounds may bedissolved or suspended in suitable liquids, such as fatty oils, liquidparaffin, or liquid polyethylene glycols. In addition, stabilizers maybe added. All formulations for oral administration should be in dosagessuitable for such administration.

For buccal administration, the compositions may take the form of tabletsor lozenges formulated in conventional manner.

For administration by inhalation, the compounds for use according to thepresent invention are conveniently delivered in the form of an aerosolspray presentation from pressurized packs or a nebulizer, with the useof a suitable propellant, e.g., dichlorodifluoromethane,trichlorofluoromethane, dichlorotetrafluoroethane, carbon dioxide, orother suitable gas. In the case of a pressurized aerosol the dosage unitmay be determined by providing a valve to deliver a metered amount.Capsules and cartridges of, e.g., gelatin for use in an inhaler orinsufflator may be formulated containing a powder mix of the compoundand a suitable powder base such as lactose or starch.

The compounds may be formulated for parenteral administration byinjection, e.g., by bolus injection or continuous infusion. Formulationsfor injection may be presented in unit dosage form, e.g., in ampoules orin multi-dose containers, with an added preservative. The compositionsmay take such forms as suspensions, solutions or emulsions in oily oraqueous vehicles, and may contain formulatory agents such as suspending,stabilizing and/or dispersing agents.

Pharmaceutical formulations for parenteral administration includeaqueous solutions of the active compounds in water-soluble form.Additionally, suspensions of the active compounds may be prepared asappropriate oily injection suspensions. Suitable lipophilic solvents orvehicles include fatty oils such as sesame oil, or synthetic fatty acidesters, such as ethyl oleate or triglycerides, or liposomes. Aqueousinjection suspensions may contain substances which increase theviscosity of the suspension, such as sodium carboxymethyl cellulose,sorbitol, or dextran. Optionally, the suspension may also containsuitable stabilizers or agents which increase the solubility of thecompounds to allow for the preparation of highly concentrated solutions.

Alternatively, the active ingredient may be in powder form forconstitution with a suitable vehicle, e.g., sterile pyrogen-free water,before use.

The compounds may also be formulated in rectal compositions such assuppositories or retention enemas, e.g., containing conventionalsuppository bases such as cocoa butter or other glycerides.

In addition to the formulations described previously, the compounds mayalso be formulated as a depot preparation. Such long acting formulationsmay be administered by implantation (for example subcutaneously orintramuscularly) or by intramuscular injection. Thus, for example, thecompounds may be formulated with suitable polymeric or hydrophobicmaterials (for example as an emulsion in an acceptable oil) or ionexchange resins, or as sparingly soluble derivatives, for example, as asparingly soluble salt.

A pharmaceutical carrier for the hydrophobic compounds of the inventionis a cosolvent system comprising benzyl alcohol, a nonpolar surfactant,a water-miscible organic polymer, and an aqueous phase. A commoncosolvent system used is the VPD co-solvent system, which is a solutionof 3% w/v benzyl alcohol, 8% w/v of the nonpolar surfactant Polysorbate80™, and 65% w/v polyethylene glycol 300, made up to volume in absoluteethanol. Naturally, the proportions of a co-solvent system may be variedconsiderably without destroying its solubility and toxicitycharacteristics. Furthermore, the identity of the co-solvent componentsmay be varied: for example, other low-toxicity nonpolar surfactants maybe used instead of POLYSORBATE 80™; the fraction size of polyethyleneglycol may be varied; other biocompatible polymers may replacepolyethylene glycol, e.g., polyvinyl pyrrolidone; and other sugars orpolysaccharides may substitute for dextrose.

Alternatively, other delivery systems for hydrophobic pharmaceuticalcompounds may be employed. Liposomes and emulsions are well knownexamples of delivery vehicles or carriers for hydrophobic drugs. Certainorganic solvents such as dimethylsulfoxide also may be employed,although usually at the cost of greater toxicity. Additionally, thecompounds may be delivered using a sustained-release system, such assemipermeable matrices of solid hydrophobic polymers containing thetherapeutic agent. Various sustained-release materials have beenestablished and are well known by those skilled in the art.Sustained-release capsules may, depending on their chemical nature,release the compounds for a few weeks up to over 100 days. Depending onthe chemical nature and the biological stability of the therapeuticreagent, additional strategies for protein stabilization may beemployed.

Many of the compounds used in the pharmaceutical combinations of theinvention may be provided as salts with pharmaceutically compatiblecounterions. Pharmaceutically compatible salts may be formed with manyacids, including but not limited to hydrochloric, sulfuric, acetic,lactic, tartaric, malic, succinic, etc. Salts tend to be more soluble inaqueous or other protonic solvents than are the corresponding free acidor base forms.

Pharmaceutical compositions suitable for use in the present inventioninclude compositions where the active ingredients are contained in anamount effective to achieve its intended purpose. More specifically, atherapeutically effective amount means an amount of compound effectiveto prevent, alleviate or ameliorate symptoms of disease or prolong thesurvival of the subject being treated. Determination of atherapeutically effective amount is well within the capability of thoseskilled in the art, especially in light of the detailed disclosureprovided herein.

The exact formulation, route of administration and dosage for thepharmaceutical compositions of the present invention can be chosen bythe individual physician in view of the patient's condition. (See e.g.,Fingl et al 1975, in “The Pharmacological Basis of Therapeutics”, Ch. 1p. 1). Typically, the dose range of the composition administered to thepatient can be from about 0.5 to 1000 mg/kg of the patient's bodyweight. The dosage may be a single one or a series of two or more givenin the course of one or more days, as is needed by the patient. Notethat for almost all of the specific compounds mentioned in the presentdisclosure, human dosages for treatment of at least some condition havebeen established. Thus, in most instances, the present invention willuse those same dosages, or dosages that are between about 0.1% and 500%,more preferably between about 25% and 250% of the established humandosage. Where no human dosage is established, as will be the case fornewly-discovered pharmaceutical compounds, a suitable human dosage canbe inferred from ED₅₀ or ID₅₀ values, or other appropriate valuesderived from in vitro or in vivo studies, as qualified by toxicitystudies and efficacy studies in animals.

Although the exact dosage will be determined on a drug-by-drug basis, inmost cases, some generalizations regarding the dosage can be made. Thedaily dosage regimen for an adult human patient may be, for example, anoral dose of between 0.1 mg and 6000 mg of each ingredient, preferablybetween 1 mg and 5000 mg, e.g. 25 to 5000 mg or an intravenous,subcutaneous, or intramuscular dose of each ingredient between 0.01 mgand 100 mg, preferably between 0.1 mg and 60 mg, e.g. 1 to 40 mg of eachingredient of the pharmaceutical compositions of the present inventionor a pharmaceutically acceptable salt thereof calculated as the freebase, the composition being administered 1 to 4 times per day.Alternatively the compositions of the invention may be administered bycontinuous intravenous infusion, preferably at a dose of each ingredientup to 400 mg per day. Thus, the total daily dosage by oraladministration of each ingredient will typically be in the range 1 to2500 mg and the total daily dosage by parenteral administration willtypically be in the range 0.1 to 400 mg. Suitably the compounds will beadministered for a period of continuous therapy, for example for a weekor more, or for months or years.

In some embodiments, the dosage range for lithium carbonate, for an oraldose, will result in blood levels of lithium being between about 0.5 andabout 1.5 meq/l. In a preferred embodiment, the lithium carbonate dosagerange, for an oral dose, will be about 900 mg/day.

In certain embodiments, the dosage range for valproate, for an oraldose, is in the range of about 250 to about 5000 mg/day. In a preferredembodiment, the valproate dosage range, for an oral dose, will be about1500 mg/day.

In further embodiments, the dosage range for zonisamide, for an oraldose, is in the range of about 25 to about 600 mg per day. In someembodiments, the dosage is 25 mg per day. In other embodiments, thedosage is 50 mg per day. In yet other embodiments, the dosage is 100 mgper day.

In further embodiments, the dosage range for mitrazepine, for an oraldose, is in the range of about 5 to about 500 mg per day. In someembodiments, the dosage is 8 mg per day. In other embodiments, thedosage is 16 mg per day. In yet other embodiments, the dosage is 32 mgper day. In some embodiments, the dosage is 15 mg per day. In otherembodiments, the dosage is 30 mg per day. In yet other embodiments, thedosage is 45 mg per day.

In other embodiments, the dosage range for venlafaxinor venlafaxin XR,for an oral dose, is in the range of about 20 mg to about 600 mg perday. In some embodiments, the dosage is 25 mg per day. In otherembodiments, the dosage is 37.5 mg per day. In yet other embodiments,the dosage is 50 mg per day. In some embodiments, the dosage is 75 mgper day. In other embodiments, the dosage is 100 mg per day. In yetother embodiments, the dosage is 150 mg per day.

Dosage amount and interval may be adjusted individually to provideplasma levels of the active moiety which are sufficient to maintain themodulating effects, or minimal effective concentration (MEC). The MECwill vary for each compound but can be estimated from in vitro data.Dosages necessary to achieve the MEC will depend on individualcharacteristics and route of administration. However, HPLC assays orbioassays can be used to determine plasma concentrations.

Dosage intervals can also be determined using MEC value. Compositionsshould be administered using a regimen that maintains plasma levelsabove the MEC for 10-90% of the time, preferably between 30-90% and mostpreferably between 50-90%.

In cases of local administration or selective uptake, the effectivelocal concentration of the drug may not be related to plasmaconcentration.

The amount of composition administered will, of course, be dependent onthe subject being treated, on the subject's weight, the severity of theaffliction, the manner of administration and the judgment of theprescribing physician.

The compositions may, if desired, be presented in a pack or dispenserdevice which may contain one or more unit dosage forms containing theactive ingredient. The pack may for example comprise metal or plasticfoil, such as a blister pack. The pack or dispenser device may beaccompanied by instructions for administration. The pack or dispensermay also be accompanied with a notice associated with the container inform prescribed by a governmental agency regulating the manufacture,use, or sale of pharmaceuticals, which notice is reflective of approvalby the agency of the form of the drug for human or veterinaryadministration. Such notice, for example, may be the labeling approvedby the U.S. Food and Drug Administration for prescription drugs, or theapproved product insert. Compositions comprising a compound of theinvention formulated in a compatible pharmaceutical carrier may also beprepared, placed in an appropriate container, and labeled for treatmentof an indicated condition.

It will be understood by those of skill in the art that numerous andvarious modifications can be made without departing from the spirit ofthe present invention. Therefore, it should be clearly understood thatthe forms of the present invention are illustrative only and are notintended to limit the scope of the present invention.

All documents and other information sources cited above are herebyincorporated in their entirety by reference, as are Gadde et al, ObesityRes. 9:544-551 (2001) and Gadde et al, JAMA 289:1820-1825 (2003).

Some Embodiments of the Invention

Some of the embodiments of the present invention are as follows:

In the first embodiment, the invention relates to a composition foraffecting weight loss comprising a first compound and a second compound,wherein said first compound is a psychotherapeutic agent and said secondcompound is an anticonvulsant.

In the second embodiment, the invention relates to the composition ofthe first embodiment, wherein said psychotherapeutic agent is selectedfrom the group consisting of lithium carbonate, lithium citrate,valproate, mixtures thereof, and pharmaceutically acceptable salts orprodrugs thereof.

In the third embodiment, the invention relates to the composition of thefirst embodiment, wherein said second compound is selected from thegroup consisting of a barbiturate, benzodiazepine, GABA analogue,hydantoins, anticonvulsant, phenyltriazine, succinimide,pharmaceutically acceptable salts or prodrugs thereof, and combinationsthereof.

In the fourth embodiment, the invention relates to the composition ofthe third embodiment, wherein said barbiturate is pentobarbital orpharmaceutically acceptable salts or prodrugs thereof.

In the fifth embodiment, the invention relates to the composition of thethird embodiment, wherein said benzodiazepine is selected from the groupconsisting of clonazepam, alprazolam, chlordiazepoxide, clorazepate,diazepam, halazepam, lorazepam, oxazepam, prazepam, flurazepam,temazepam, triazolam, pharmaceutically acceptable salts or prodrugsthereof, and combinations thereof

In the sixth embodiment, the invention relates to the composition of thethird embodiment, wherein said GABA analogue is selected from the groupconsisting of tiagabine, gabapentin, pregabalin, pharmaceuticallyacceptable salts or prodrugs thereof, and combinations thereof.

In the seventh embodiment, the invention relates to the composition ofthe third embodiment, wherein said hydantoin is selected from the groupconsisting of fosphenytoin, phenytoin, 5,5-Diphenylhydantoin,pharmaceutically acceptable salts or prodrugs thereof, and combinationsthereof.

In the eighth embodiment, the invention relates to the composition ofthe third embodiment, wherein said miscellaneous anticonvulsant isselected from the group consisting of carbamazepine, valproate, valproicacid, divalproex, felbamate, levetiracetam, carbamazepine, topiramate,oxcarbazepine, zonisamide, pharmaceutically acceptable salts or prodrugsthereof, and combinations thereof.

In the ninth embodiment, the invention relates to the composition of thethird embodiment, wherein said phenyltriazine is lamotrigine.

In the tenth embodiment, the invention relates to the composition of thethird embodiment, wherein said succinimide is selected from the groupconsisting of methsuximide, ethosuximide, and combinations thereof.

In the eleventh embodiment, the invention relates to the composition ofthe first embodiment, wherein said first compound is a pyschotherapeuticagent and said second compound is a zonisamide.

In the twelfth embodiment, the invention relates to the composition ofthe first embodiment, wherein said first compound is lithium carbonateor lithium citrate and said second compound is zonisamide.

In the thirteenth embodiment, the invention relates to the compositionof the first embodiment, wherein said first compound is valproate andsaid second compound is zonisamide.

In the fourteenth embodiment, the invention relates to the compositionof the twelfth or thirteenth embodiment, wherein the zonisamide is in atime-release formulation.

In the fifteenth embodiment, the invention relates to a method ofaffecting weight loss, comprising identifying an individual in needthereof and treating that individual with a psychotherapeutic agent andan anticonvulsant.

In the sixteenth embodiment, the invention relates to the method of thefifteenth embodiment, wherein said individual has a body mass indexgreater than 25.

In the seventeenth embodiment, the invention relates to the method ofthe fifteenth embodiment, wherein the psychotherapeutic agent isselected from the group consisting of lithium carbonate, lithiumcitrate, and valproate, extended release formulations of the abovedrugs, and combinations of the above drugs.

In the eighteenth embodiment, the invention relates to the method of thefifteenth embodiment, wherein the anticonvulsant is selected from thegroup consisting of barbiturates, benzodiazepines, GABA analogues,hydantoins phenyltriazines, and succinimides, and pharmaceuticallyacceptable salts or prodrugs thereof.

In the ninteenth embodiment, the invention relates to the method of thefifteenth embodiment, wherein the anticonvulsant is selected from thegroup consisting of pentobarbital, clonazepam, clorazepate,benzodiazepine, diazepam, tiagabine, gabapentin, pregabalin,fosphenytoin, phenytoin, phenytoin, 5,5-Diphenylhydantoin,carbamazepine, valproate, valproic acid, divalproex, felbamate,levetiracetarn, carbamazepine, topiramate, oxcarbazepine, zonisamide,lamotrigine, methsuximide, ethosuximide, extended release formulationsof the above drugs, and combinations of the above drugs.

In the twentieth embodiment, the invention relates to the method of thefifteenth embodiment, wherein said first compound and said secondcompound are administered nearly simultaneously.

In the twenty first embodiment, the invention relates to the method ofthe fifteenth embodiment, wherein said first compound is administeredprior to said second compound.

In the twenty second embodiment, the invention relates to the method ofthe fifteenth embodiment, wherein said first compound is administeredsubsequent to said second compound.

In the twenty third embodiment, the invention relates to a method ofincreasing satiety in an individual comprising identifying an individualin need thereof and treating that individual with a first compound and asecond compound, wherein said first compound is a psychotherapeuticagent and said second compound is a anticonvulsant.

In the twenty fourth embodiment, the invention relates to the method ofthe twenty third embodiment, wherein said first compound and said secondcompound are administered nearly simultaneously.

In the twenty fifth embodiment, the invention relates to the method ofthe twenty third embodiment, wherein said first compound is administeredprior to said second compound.

In the twenty sixth embodiment, the invention relates to the method ofthe twenty third embodiment, wherein said first compound is administeredsubsequent to said second compound.

In the twenty seventh embodiment, the invention relates to a method ofincreasing energy expenditure in an individual comprising identifying anindividual in need thereof and treating that individual with a firstcompound and a second compound, wherein said first compound is apsychotherapeutic agent and said second compound is an anticonvulsant.

In the twenty eighth embodiment, the invention relates to the method ofthe twenty seventh embodiment, wherein said first compound and saidsecond compound are administered nearly simultaneously.

In the twenty ninth embodiment, the invention relates to the method ofthe twenty seventh embodiment, wherein said first compound isadministered prior to said second compound.

In the thirtieth embodiment, the invention relates to the method of thetwenty seventh embodiment, wherein said first compound is administeredsubsequent to said second compound.

In the thirty first embodiment, the invention relates to a method ofsuppressing the appetite of an individual comprising identifying anindividual in need thereof and treating that individual with a firstcompound and a second compound, wherein said first compound is apsychotherapeutic agent and said second compound is an anticonvulsant.

In the thirty second embodiment, the invention relates to the method ofthe thirty first embodiment, wherein said first compound and said secondcompound are administered nearly simultaneously.

In the thirty third embodiment, the invention relates to the method ofthe thirty first embodiment, wherein said first compound is administeredprior to said second compound.

In the thirty fourth embodiment, the invention relates to the method ofthe thirty first embodiment, wherein said first compound is administeredsubsequent to said second compound.

In the thirty fifth embodiment, the invention relates to a method ofaffecting weight loss in an individual comprising identifying anindividual in need thereof and treating that individual with acombination of lithium carbonate and zonisamide.

In the thirty sixth embodiment, the invention relates to a method ofaffecting weight loss in an individual comprising identifying anindividual in need thereof and treating that individual with acombination of valproate and zonisamide.

In the thirty seventh embodiment, the invention relates to the method ofthe thirty fifth or thirty sixth embodiments, wherein the individual hasa BMI greater than 30.

In the thirty eighth embodiment, the invention relates to the method ofthe thirty fifth or thirty sixth embodiments, wherein the individual hasa BMI greater than 25.

In the thirty ninth embodiment, the invention relates to the method ofthe thirty fifth or thirty sixth embodiments, wherein the lithiumcarbonate or valproate is in a time-release formulation.

In the fortieth embodiment, the invention relates to the method of thethirty fifth or thirty sixth embodiments, wherein the plasmaconcentration level of both the lithium carbonate or valproate andzonisamide follow a similar concentration profile.

In the forty first embodiment, the invention relates to the method ofthe thirty ninth embodiment, wherein the lithium carbonate or valproateand the zonisamide are administered substantially simultaneously.

In the forty second embodiment, the invention relates to the method ofthe thirty ninth embodiment, wherein the lithium carbonate or valproateis administered prior to the zonisamide.

In the forty third embodiment, the invention relates to the method ofthe thirty ninth embodiment, wherein the lithium carbonate or valproateis administered subsequent to the zonisamide.

EXAMPLES

The examples below are non-limiting and are merely representative ofvarious aspects of the invention.

Example 1 Use of Zonisamide Alone

Individuals taking an antidepressant, or about to take anantidepressant, who have gained weight as the result of the use of theantidepressant, or are susceptible to gain weight as the result of theuse of the antidepressant, are identified. Each individual is instructedto take one 25 mg tablet of zonisamide on a daily basis, in addition tothe antidepressant therapy.

The individuals are monitored for a period of months. It is recommendedthat the dosage be adjusted so that each individual loses weight at arate of 10% of initial weight every 6 months. However, the rate of weighloss for each individual may be adjusted by the treating physician basedon the individual's particular needs.

The dosage of zonisamide can be from about 25 mg to about 800 mg perday, generally given once per day or divided (e.g., equally) intomultiple doses. Preferably, the dose is from about 100 mg to about 600mg per day, more preferably, the dose is from about 200 mg to about 400mg per day. However, it may be necessary to use dosages outside theseranges. Zonisamide tablets are usually made and marketed in 25 mg, 50mg, and 100 mg doses. Individual tablets, or combination of tablets canbe used to achieve the desired dosing.

Example 2 Use of Topiramate Alone

Individuals taking an antidepressant, or about to take anantidepressant, who have gained weight as the result of the use of theantidepressant, or are susceptible to gain weight as the result of theuse of the antidepressant, are identified. Each individual is instructedto take one 25 mg tablet of topiramate on a daily basis, in addition tothe antidepressant therapy.

The individuals are monitored for a period of months. It is recommendedthat the dosage be adjusted so that each individual loses weight at arate of 10% of initial weight every 6 months. However, the rate of weighloss for each individual may be adjusted by the treating physician basedon the individual's particular needs.

The dosage of topiramate can be from about 25 mg to about 1600 mg,preferably from about 50 mg to about 600 mg, more preferably from about100 mg to about 400 mg. However, it may be necessary to use dosagesoutside these ranges.

Example 3 Combination of Zonisamide and Mitrazepine

Individuals having a BMI of greater than 25 are identified. Eachindividual is instructed to take one tablet of zonisamide on a dailybasis, in addition to one tablet of mitrazepine on a daily basis.Initially, the drugs are administered as follows: 8 mg mitrazepine and64 mg zonisamide; or 16 mg mitrazepine and 128 mg zonisamide; or 32 mgmitrazepine and 252 mg zonisamide; generally with anmitrazepine/zonisamide ratio of 1:8.

The individuals are monitored for a period of months. It is recommendedthat the dosage be adjusted so that each individual loses weight at arate of 10% of initial weight every 6 months. However, the rate of weighloss for each individual may be adjusted by the treating physician basedon the individual's particular needs.

If the initial dosages are not effective, they can be increased.

Example 4 Combination of Zonisamide and Paroxetine

Individuals having a BMI of greater than 25 are identified. Eachindividual is instructed to take one tablet of zonisamide on a dailybasis, in addition to one tablet of paroxetine on a daily basis.Initially, the drugs are administered as follows: 10 mg paroxetine and60 mg zonisamide; or 20 mg paroxetine and 120 mg zonisamide; or 30 mgparoxetine and 180 mg zonisamide; or 40 mg paroxetine and 240 mgzonisamide; generally with an paroxetine/zonisamide ratio of 1:6.

The individuals are monitored for a period of months. It is recommendedthat the dosage be adjusted so that each individual loses weight at arate of 10% of initial weight every 6 months. However, the rate of weighloss for each individual may be adjusted by the treating physician basedon the individual's particular needs.

If the initial dosages are not effective, they can be increased.

Example 5 Combination of Zonisamide and Lithium Carbonate

Individuals having a BMI of greater than 25 are identified. Eachindividual is instructed to take one 25 mg tablet of zonisamide on adaily basis, in addition to one 300 mg tablet of lithium carbonate on adaily basis.

The individuals are monitored for a period of months. It is recommendedthat the dosage be adjusted so that each individual loses weight at arate of 10% of initial weight every 6 months. However, the rate of weighloss for each individual may be adjusted by the treating physician basedon the individual's particular needs.

If the initial dosage is not effective, then the zonisamide dosage canbe increased by approximately 25 mg per day. If the initial dosageresults in a more rapid weight loss than the above rate, the dosage ofeach of zonisamide or lithium carbonate can be reduced.

In some cases, it is beneficial to administer one dose of zonisarnideper day in conjunction with two or three or more doses of lithiumcarbonate throughout the day. Lithium carbonate may also be in atime-release formulation where the dose is administered once a day, butlithium carbonate gradually enters the blood stream throughout the day,or in the course of a 12 hour period.

The above procedure can be followed using lithium citrate, or any otherpharmaceutically acceptable salt of lithium, instead of lithiumcarbonate.

Example 6 Combination of Zonisamide and Lithium Carbonate

Individuals having a BMI of greater than 25 are identified. Eachindividual is instructed to take one 25 mg tablet of zonisamide on adaily basis. In addition, each individual is instructed to take one 300mg tablet of lithium carbonate on a daily basis.

The individuals are monitored for a period of months. It is recommendedthat the dosage be adjusted so that each individual loses weight at arate of 10% of initial weight every 6 months. However, the rate of weighloss for each individual may be adjusted by the treating physician basedon the individual's particular needs. It is recommended that serumcreatinine be checked periodically.

If the initial dosage is not effective, then the lithium carbonatedosage can be increased so as to achieve blood levels of 0.5 to 1.5meq/l. If the initial dosage results in a more rapid weight loss thanthe above rate, the dosage of each of zonisamide or lithium carbonatecan be reduced.

The above procedure can be followed using lithium citrate, or any otherpharmaceutically acceptable salt of lithium, instead of lithiumcarbonate.

Example 7 Combination of Zonisamide and Valproate

Individuals having a BMI of greater than 25 are identified. Eachindividual is instructed to take one 50 mg tablet of zonisamide on adaily basis, in addition to one 500 mg tablet of valproate on a dailybasis.

The individuals are monitored for a period of months. It is recommendedthat the dosage be adjusted so that each individual loses weight at arate of 10% of initial weight every 6 months. However, the rate of weighloss for each individual may be adjusted by the treating physician basedon the individual's particular needs.

If the initial dosage is not effective, then the zonisarnide dosage canbe increased by approximately 30 mg per day, though not exceeding 600 mgtotal per day. If the initial dosage results in a more rapid weight lossthan the above rate, the dosage of each of zonisamide or valproate canbe reduced.

In some cases, it is beneficial to administer one dose of zonisamide perday in conjunction with two or three or more doses of valproatethroughout the day. Valproate may also be in a time-release formulationwhere the dose is administered once a day, but valproate graduallyenters the blood stream throughout the day, or in the course of a 12hour period.

Example 8 Combination of Zonisamide and Valproate

Individuals having a BMI of greater than 25 are identified. Eachindividual is instructed to take one 50 mg tablet of zonisamide on adaily basis. In addition, each individual is instructed to take one 250mg tablet of valproate on a daily basis.

The individuals are monitored for a period of months. It is recommendedthat the dosage be adjusted so that each individual loses weight at arate of 10% of initial weight every 6 months. However, the rate of weighloss for each individual may be adjusted by the treating physician basedon the individual's particular needs.

If the initial dosage is not effective, then the valproate dosage can beincreased by 20 mg intervals up to 3000 mg per day. If the initialdosage results in a more rapid weight loss than the above rate, thedosage of each of zonisamide or valproate can be reduced.

Example 9 Combination of Zonisamide and Olanzapine

Individuals having a BMI of greater than 25 are identified. Eachindividual is instructed to take one tablet of zonisamide on a dailybasis, in addition to one tablet of olanzapine on a daily basis.Initially, the drugs are administered as follows: 5 mg olanzapine and 60mg zonisamide, or 10 mg olanzapine and 120 mg zonisamide; generally withan olanzapine/zonisamide ratio of 1:12.

The individuals are monitored for a period of months. It is recommendedthat the dosage be adjusted so that each individual loses weight at arate of 10% of initial weight every 6 months. However, the rate of weighloss for each individual may be adjusted by the treating physician basedon the individual's particular needs.

If the initial dosages are not effective, they can be increased.

Example 10 Combination of Zonisamide and Risperidone

Individuals having a BMI of greater than 25 are identified. Eachindividual is instructed to take one tablet of zonisamide on a dailybasis, in addition tablet of risperidone on a daily basis. Initially,the drugs are administered as follows: 0.5 mg risperidone and 30 mgzonisamide, 1 mg risperidone and 60 mg zonisamide, or 2 mg risperidoneand 120 mg zonisamide; generally with an olanzapine/zonisamide ratio of1:60.

The individuals are monitored for a period of months. It is recommendedthat the dosage be adjusted so that each individual loses weight at arate of 10% of initial weight every 6 months. However, the rate of weighloss for each individual may be adjusted by the treating physician basedon the individual's particular needs.

If the initial dosages are not effective, they can be increased.

Example 11 Zonisamide and/or Bupropion Prevent the Weight GainAssociated with Mirtazapine or Setiptiline Treatment Background

Mirtazapine shows considerable promise as a therapy for sleep apnea, butit causes weight gain in some patients. This weight gain limits the useof mirtazapine as a therapy for sleep apnea or as an antidepressant.Addition of zonisamide, or bupropion, or zonisamide plus bupropion, toconcomitant mirtazapine treatment decreases the weight gain associatedwith mirtazapine, in a rodent model of mirtazapine-induced weight gain.

The melanocortin system controls energy balance. Mirtazapine andsetiptiline change the activity of melanocortin circuits. Zonisamide, orbupropion, or zonisamide plus bupropion reverse this change in neuronalactivity.

The melanocortin system consists of Proopiomelanocortin (POMC) neurons,the cognate melanocortin receptors (MC4 R) and the agouti-relatedpeptide neurons in the arcuate nucleus of the hypothalamus. It is wellestablished in humans and animals that the melanocortin system controlsenergy balance and the most common genetic cause of obesity in humans iscongenital lack of MC4 R.

It has recently been shown that many compounds that influence energybalance modify the activity of melanocortin circuits. In particular, ithas been shown that bupropion and zonisamide increase theelectrophysiological activity of POMC neurons. As part of this researchsome of the receptors that can regulate the activity of POMC neuronshave been identified; specifically it has been shown that 5-HT 2C and5-HT 1B receptors increase the activity of POMC neurons as does dopamineD2 R. The clear role of 5-HT 2CR in regulating the activity of POMCneurons suggests that compounds like mirtazapine, which is an antagonistat this receptor, modify energy balance to induce an anabolic state,favoring weight gain.

In vivo Pharmacology

We have developed a model to pre-clinically test the effects ofmirtazapine on body weight gain. Dose-ranging studies are performed todetermine the dose that best demonstrates the weight gain caused bymirtazapine or by setiptiline in the “rat-weight gain assay”.Zonisamide, or bupropion, or zonisamide plus bupropion are tested todecrease the weight gain seen in response to concomitant mirtazapine orsetiptiline therapy. Initially, a dose of 30 mg/kg of zonisamide (bid)is used, but the dose in the experiment ranges from 20 mg/kg to 90 mg/kg(bid). Bupropion is used initially at a dose of 190 mg/kg/day, the dosein the experiment ranges from 50-190 mg/kg/day. Mirtazapine orsetiptiline are used as solutions in minipumps. The concentration of thesolution ranges between 0.1 μM to 10 mM. In some experiments, theconcentration is calculated to provide a dose of about 1 mg/kg/day. Incertain experiments, the concentration is 10 μM.

In a 4×3 design rats receive implants that secrete mirtazapine, orsetiptiline, or vehicle. Some rats also receive co-treatment withsaline, some receive zonisamide, some receive bupropion, and othersreceive co-treatment with zonisamide plus bupropion. In this way cohortsof 10 rats receive all possible combinations of the weight loss drug(s)with mirtazapine or setiptiline.

Rat numbers and groups Weight loss agent Vehicle Setiptiline (tbd)Mirtazapine (tbd) Vehicle 10 10 10 Zonisamide (tbd) 10 10 10 Bupropion(tbd) 10 10 10 Zonisamide (tbd) + 10 10 10 Bupropion (tbd)

Electrophysiology

The electrophysiological response of POMC neurons to mirtazapine and tosetiptiline is determined. It is then determined if co-treatment withzonisamide, or bupropion, or zonisamide plus bupropion prevents theexpected decrease in POMC activity due to mirtazapine or setiptiline.

Preliminary data show that sub-threshold doses of zonisamide andbupropion synergistically inhibit acute food intake in mice, which isfurther evidence of powerful synergy between zonisamide and bupropion toinhibit food intake in mice after a 16 hr fast.

In other preclinical experiments it has been shown that zonisamide andbupropion each inhibit food intake. These effects had faded by 4 hours,but the combination was effective when each compound alone wasineffective. The weight reducing effects of zonisamide and bupropionhave also been well demonstrated in humans (Gadde et al, 2003; Gadde etal, 2001).

It has also been shown that zonisamide in combination with bupropionstrongly increases the electrophysiological activity of POMC neurons inbrain slices from POMC-EGFP mice. It has been shown that a largeincrease in rate of spontaneous action potentials in POMC neurons wouldbe expected to stimulate significant secretion of α-MSH from POMCneurons, and consequent activation of MC4 R—to inhibit food intake anddecrease body weight gain.

Procedures In vivo Pharmacology

Female Sprague-Dawley rats weighing about 300 grams at the start of theexperiment are used. Under isoflurane anesthesia, Alzet osmoticminipumps (2ml2) are implanted subcutaneously between the shoulderblades. The rats are returned to their home cages after recovery. Theminipumps deliver 5 μL per hour for 14 days. A range of doses ofmirtazapine (from 0.1 to 20mg/kg/day dissolved in DMSO/saline) are used.Animals are housed individually and supplied with standard laboratorychow. Food consumed and animal weights are recorded every 3 days, tominimize disruption of the animals.

We have already shown in mice that bupropion, zonisamide, andzonisarnide plus bupropion have pronounced effects on food intake afterintra-peritoneal injection. We will develop chronic infusion methods totest the effects of bupropion, or zonisamide and zonisamide plusbupropion on weight gain over 14 days using the following groups:

7 groups of 6 rats (6 doses of mirtazapine (0.1, 0.5, 1, 5, 10, 20mg/kg), +saline)

The doses of zonisamide, and bupropion, and zonisarnide plus bupropionthat cause weight loss in this rat model in the preliminary studies aredetermined; the co-treatment experiments (mirtazapine plus zonisamideplus bupropion) are then performed.

Electrophysiology

The electrophysiological activity of Proopiomelanocortin (POMC) neuronsin brain slices from POMC-EGFP mice are recorded. The POMC neurons inthese mice are identified by the expression of green fluorescent protein(EGFP) in these, and only these, cells. The frequency of actionpotentials in these neurons are recorded using standardelectrophysiological techniques. In particular loose cell attached patchconfiguration is used to determine action potential frequency, whilstminimally disturbing the cells.

It has been shown that zonisamide, or bupropion, or zonisamide plusbupropion increase the activity of POMC neurons. The basal activity isrecorded, and then mirtazapine or setiptiline is added to the tissuebath to determine the effect of the antidepressant on the activity ofPOMC neurons. If mirtazapine or setiptiline inhibits the activity ofPOMC neurons, the increase in neuronal activity by treating the brainslices with bupropion, or zonisamide or zonisamide plus bupropion istested.

Example 11 Zonisamide Plus Bupropion Prevent the Weight Gain Associatedwith Olanzapine Treatment Background

In this experiment, the effect of co-treatment with drug combinations onthe weight gain associated with olanzapine use is tested. Specifically,addition of zonisamide or zonisamide plus bupropion to concomitantolanzapine treatment is shown to decrease the weight gain associatedwith olanzapine, in a validated rodent model of olanzapine-inducedweight gain.

The melanocortin system consists of Proopiomelanocortin (POMC) neurons,the cognate melanocortin receptors (MC4 R) and the agouti-relatedpeptide neurons in the arcuate nucleus of the hypothalamus. It is wellestablished in humans and animals that the melanocortin system controlsenergy balance, and the most common genetic cause of obesity in humansis congenital lack of MC4 R. It has recently been shown that manycompounds that influence energy balance modify the activity ofmelanocortin circuits. In particular, it has been shown that bupropionand zonisamide increase the electrophysiological activity of POMCneurons. It has also been shown that cannabinoid antagonists activatethis same circuitry. We have identified some of the receptors that canregulate the activity of POMC neurons; in particular we have shown that5-HT 2C and 5-HT 1 B receptors increase the activity of POMC neurons asdoes dopamine D2 R. The clear role of D2 R and 5-HT 2CR in regulatingthe activity of POMC neurons shows that compounds like olanzapine, whichis an antagonist at both these receptors, modify energy balance toinduce an anabolic state, favoring weight gain.

Study Design In vivo Pharmacology

Rats receive implants that secrete olanzapine (or vehicle in controlgroups). Some also receive co-treatment with zonisamide; others getco-treatment with zonisamide plus bupropion. Initially, a dose of 30mg/kg of zonisamide (bid) is used, but the dose in the experiment rangesfrom 20 mg/kg to 90 mg/kg (bid). Bupropion is used initially at a doseof 190 mg/kg/day, the dose in the experiment ranges from 50-190mg/kg/day. Olanzapine is used as a solution in minipumps. Theconcentration of the solution ranges between 0.1 μM to 10 mM. In someexperiments, the concentration is calculated to provide a dose of about1.75 mg/kg/day. In certain experiments, the concentration is 10 μM.

Rat numbers and groups Weight loss agent Vehicle Olanzapine (1.75mg/day) Vehicle 10 10 Zonisamide (tbd) 10 10 Zonisamide (tbd) + 10 10bupropion (tbd)

Preliminary data on the effect of zonisamide combined with bupropion onelectrophysiological activity of POMC neurons in brain slices fromPOMC-EGFP mice show the increase in rate of spontaneous actionpotentials in POMC neurons. This large increase stimulates significantsecretion of α-MSH from POMC neurons, and consequently activates MC4R—to inhibit food intake and decrease body weight gain.

Procedures In vivo Pharmacology

Female Sprague-Dawley rats weighing about 300 grams at the start of theexperiment are used. Under isoflurane anesthesia, Alzet osmoticminipumps (2ml2) are implanted subcutaneously, between the shoulderblades. The rats are returned to their home cages after recovery. Theminipumps deliver 5 μL per hour for 14 days. Olanzapine is dissolved indH₂O+10% dilute lactic acid. A pH of about 3.5 enables the olanzapine todissolve completely and produce a golden solution. This pH level has noeffect on the animals in either the drug groups or the vehicle group.The animals are housed individually and are supplied with standardlaboratory chow. Food consumed and animal weights are recorded every 3days, to minimize disruption of the animals.

It has been shown in mice that zonisamide and zonisamide plus bupropionhave pronounced effects on food intake over 24 hrs afterintra-peritoneal injection. Similar mini-pump based methods aredeveloped to test the effects of zonisamide and zonisamide plusbupropion on weight gain over 14 days using the following groups:

7 groups of 6 rats (6 doses of zonisamide, +saline)

7 groups of 6 rats (6 doses of bupropion, +saline)

The doses of zonisamide and bupropion that cause weight loss in this ratmodel are determined in smaller preliminary studies. The co-treatmentexperiments (olanzapine plus zonisamide plus bupropion) are thenperformed. Total animals tested are: 60+42+42=144 rats. The experimentsare run three times to confirm the results.

Electrophysiology

The electrophysiological activity of Proopiomelanocortin (POMC) neuronsin brain slices from POMC-EGFP mice are recorded. The POMC neurons inthese mice are identified by the expression of green fluorescent protein(EGFP) in these, and only these, cells. The frequency of actionpotentials in these neurons are recorded using standardelectrophysiological techniques. In particular, loose cell attachedpatch configuration is used to determine action potential frequency,whilst minimally disturbing the cells.

It has been shown that zonisamide and zonisamide plus bupropion increasethe activity of POMC neurons. The basal activity is recorded, and thenolanzapine is added to the tissue bath to determine the effect ofolanzapine on the activity of POMC neurons. Pharmacological data showthat olanzapine decreases the activity of POMC neurons. Then theincrease in neuronal activity is tested again by treating the brainslices with zonisamide or zonisamide plus bupropion.

Example 12 Case Study of Combination of Zonisamide, Lamotrogine, andClonazepam

A 49 year-old woman having biopolar disorder, Type I, had been treatedfor just over year by her psychiatrist using clonazepam 1 mg qHS,fluoxetine 20 mg qd, and lamotrogine 300 mg qD. One particular complaintwas that she had “constant thoughts of eating”. Her psychiatrist startedher on zonisamide 100 mg qD. She reported that the zonisamidesignificantly reduced her craving for food and prevented weight gain.The dose was continued and despite multiple stressors at home, shecontinued to do well on the treatment regimen.

Example 13 Case Study of Combination of Zonisamide, Paroxetine andRisperidone

A 45 year old female patient with social phobia and schizoaffectivedisorder was treated with paroxetine augmented with risperidone. She hadmarked increase in appetite and gained 40 pounds. A trial of bupropionalone did not cause significant weight loss. She was therefore startedon zonisamide 100 mg, incraesed to 200mg. In 3 weeks she lost 12 pounds.The dose was then increased to 300 mg and then to 600 mg. In 5 monthsher weight returned to baseline. The psychiatric symptoms also improved.

Example 14 Case Study of Combination of Zonisamide, Olanzapine,Valproate, and Bupropion

A 30 year-old female patient with a diagnosis of bipolar disorder gained56 lbs while receiving olanzapine and valproate over 5 years. Despitesignificant weight gain, as her mental illness was effectivelycontrolled, these medications were continued. She was clinically obesewith a BMI of 33.8 kg/m². In an effort to assist in weight reduction,bupropion was added at 150 mg/day while olanzapine and valproate werecontinued. When bupropion dose was raised to 300 mg/day, the patientreported feeling hyperactive; hence, the dose was reduced back to 150mg/day. After 6 months, the patient lost 23.6 lbs. However, whilecontinuing to receive bupropion, the patient regained 10.6 lbs over thenext 10 months. At this point, zonisamide was added to her medicationregimen at 100 mg/day and the dose was increased to 200 mg/day after twoweeks. The patient lost 15 lbs over the next 4 months and reported noadverse effects. She remained free of bipolar disorder symptoms.

The case illustrates two advantages of the combination therapy ofbupropion and zonisamide. 1) Although bupropion helped in decreasingweight gain resulting from olanzapine and valproate, the patient couldnot take a higher dose (300-400 mg/day) of bupropion because ofprecipitation of hypomanic symptoms. The risk of induction of manic orhypomanic symptoms with use of antidepressant medications in susceptiblepatients is well documented. 2) Zonisamide helped in further offsettingweight gain associated with olanzapine and valproate after the patientlost weight initially with bupropion and regained some of weight lost.

1. A pharmaceutical composition for the prevention of weight gainassociated with the use of a psychotherapeutic agent comprising a firstcompound and a second compound, wherein said first compound is apsychotherapeutic agent and said second compound is an anticonvulsant.2. The pharmaceutical composition of claim 1, wherein saidpsychotherapeutic agent is selected from the group consisting of lithiumcarbonate, lithium citrate, valproate, mixtures thereof, andpharmaceutically acceptable salts or prodrugs thereof.
 3. Thepharmaceutical composition of claim 1, wherein said anticonvulsant isselected from the group consisting of topiramate, zonisamide, andpharmaceutically acceptable salts or prodrugs thereof, and combinationsthereof.
 4. The pharmaceutical composition of claim 1, wherein saidfirst compound is a pyschotherapeutic agent and said second compound isa zonisamide.
 5. The pharmaceutical composition of claim 4, wherein saidfirst compound is lithium carbonate or lithium citrate.
 6. Thepharmaceutical composition of claim 4, wherein said first compound isvalproate.
 7. The pharmaceutical composition of claim 1, wherein saidfirst compound is a salt of lithium and said second compound iszonisamide.
 8. The pharmaceutical composition of claim 1, wherein saidfirst compound is valproic acid, or a pharmaceutically acceptable salt,ester, amide, or prodrug thereof, and said second compound iszonisamide.
 9. The pharmaceutical composition of claim 1, wherein saidfirst compound is mirtazapine and said second compound is zonisamide.10. The pharmaceutical composition of claim 1, wherein said firstcompound is mirtazapine and said second compound is bupropion.
 11. Thepharmaceutical composition of claim 1, wherein said first compound issetiptiline and said second compound is zonisamide.
 12. Thepharmaceutical composition of claim 1, wherein said first compound issetiptiline and said second compound is bupropion.
 13. Thepharmaceutical composition of claim 1, wherein said first compound ismirtazapine and said second compound is a combination of zonisamide andbupropion.
 14. The pharmaceutical composition of claim 1, wherein saidfirst compound is setiptiline and said second compound is a combinationof zonisamide and bupropion.
 15. A method of preventing weight lossassociated with the use of a psychotherapeutic agent, comprisingidentifying an individual in need thereof and treating that individualwith a psychotherapeutic agent and an anticonvulsant.
 16. The method ofclaim 15, wherein the psychotherapeutic agent is selected from the groupconsisting of lithium carbonate, lithium citrate, and valproate, andpharmaceutically acceptable salts, esters, amides, or prodrugs thereof,and said anticonvulsant is zonisamide.
 17. The method of claim 15,wherein the psychotherapeutic agent is selected from the groupconsisting of mirtazapine, and setiptiline, and pharmaceuticallyacceptable salts, esters, amides, or prodrugs thereof, and saidanticonvulsant is zonisamide.
 18. A method of suppressing the appetiteof an individual comprising identifying an individual in need thereofand treating that individual with a first compound and a secondcompound, wherein said first compound is a psychotherapeutic agent andsaid second compound is an anticonvulsant.
 19. The method of claim 18,wherein the psychotherapeutic agent is selected from the groupconsisting of lithium carbonate, lithium citrate, and valproate, andpharmaceutically acceptable salts, esters, amides, or prodrugs thereof,and said anticonvulsant is zonisamide.
 20. The method of claim 18,wherein the psychotherapeutic agent is selected from the groupconsisting of mirtazapine, and setiptiline, and pharmaceuticallyacceptable salts, esters, amides, or prodrugs thereof, and saidanticonvulsant is zonisamide.